Clavicular Tunnel Complications after Coracoclavicular Reconstruction in Acute Acromioclavicular Dislocation: Coracoid Loop versus Coracoid Tunnel Fixation

Background@#The purpose of this study was to compare clavicular tunnel complications after coracoclavicular (CC) reconstruction between a coracoid loop fixation group and a coracoid tunnel fixation group. We hypothesized that clavicular tunnel complications would be more common in the coracoid loop group. @*Methods@#This retrospective study evaluated 24 patients who underwent CC reconstruction using coracoid tunnel fixation (n = 14) and coracoid loop fixation (n = 10). Radiographic measurements included the CC distance and clavicular tunnel diameter. Clavicular tunnel complications such as tunnel widening and clavicular tunnel fractures were investigated. Clinical outcomes were assessed using the American Shoulder and Elbow Surgeons Shoulder score and the University of California at Los Angeles Shoulder score. @*Results@#The mean follow-up period was 17.5 months (range, 11–38 months). The final clavicular tunnel diameter and the increase in the clavicular tunnel diameter in millimeter and percentage were significantly greater in the coracoid loop group than in the coracoid tunnel group (all p < 0.05). Clavicular tunnel widening more than 100% was found in 5 patients, all belonging to the coracoid loop group. Clavicular tunnel fractures occurred in 3 patients (all in the coracoid loop group). Fracture was associated with severe tunnel widening (more than 100% increase). The mean value of the final clavicular tunnel diameter in patients with fractures was significantly larger than that in patients without (12.7 ± 3.3 mm vs. 8.4 ± 1.5 mm, p = 0.016). @*Conclusions@#Clavicular tunnel complications such as significant tunnel widening and fractures after CC reconstructions in acromioclavicular dislocations were common with the coracoid loop fixation technique. A greater clavicular tunnel widening and resultantly enlarged tunnel diameter might increase the risk of fracture through the clavicular tunnel.

Intraoperative Templating in Lateral Meniscal Allograft Transplantation

Recently, studies have emphasized the importance of anatomical placement of the lateral meniscal allograft to decrease postoperative extrusion. However, it is infeasible to identify the exact rotation of the allograft during transplantation. We present a patient who underwent a lateral meniscal transplantation using a wire for correct positioning of the allograft. The use of a wire intraoperatively shaped to resemble the contour of the lateral meniscal allograft will aid in more accurate and anatomical graft placement.

Postoperative Evaluation after Anterior Cruciate Ligament Reconstruction: Measurements and Abnormalities on Radiographic and CT Imaging

Reconstruction of a ruptured anterior cruciate ligament (ACL) is a well-established procedure for repair of ACL injury. Despite improvement of surgical and rehabilitation techniques over the past decades, up to 25% of patients still fail to regain satisfactory function after an ACL reconstruction. With development of CT imaging techniques for reducing metal artifacts, multi-planar reconstruction, and three-dimensional reconstruction, early post-operative imaging is increasingly being used to provide immediate feedback to surgeons regarding tunnel positioning, fixation, and device placement. Early post-operative radiography and CT imaging are easy to perform and serve as the baseline examinations for future reference.

Management of Meniscal Injury: Repair, Meniscectomy, and Transplantation / 대한정형외과학회잡지

Although total meniscectomy had been performed as a treatment of meniscal tear, many published articles reported progression of the degeneration process and development of the osteoarthritis after meniscectomy. Meniscal repair has been performed increasingly, with the increased knowledge of the biomechanical properties of the meniscus. However, resection of the meniscus is still needed for irreparable tear and should be performed as minimally as possible to maintain the important functions of the meniscus. When substantial meniscal tissue is resected, meniscal allograft transplantation is considered to be a therapeutic option for young active patients to prevent the progress of degenerative change of the cartilage. In this review, indications and outcomes after meniscectomy, meniscal repair, and meniscal transplantation for the treatment of the meniscal injury are discussed.

Cell Based Treatment for Middle Age Patients with Osteoarthritis

While many treatments have been performed to repair the chondral defects during last two decades, most of the repaired tissue has shown fibrocartilage or hyaline-like cartilage. Therefore, the clinical outcomes of conventional treatments are unrealiable and unpredictable. Cell-based treatments have recently emerged to regenerate the cartilage with better biomechanical properties and histological quality so that it resembles nature hyaline cartilage. This review discusses the current methodology of the cell-based treatments and their clinical outcomes.

Pain in Patients Evaluated in Outpatient Orthopaedic Clinics

PURPOSE: We performed this study to assess pain in patients seen in member outpatient orthopaedic clinics of the Korean Knee Society (KKS). MATERIALS AND METHODS: We organized a committee for the study of knee joint pain. The committee designed a questionnaire form consisting of 11 items related to pain. One hundred thirty-five regular members of the KKS asked all patients visiting their respective outpatient clinics during May 2007 to complete the questionnaire form. Although 12,418 patients agreed to fill out the questionnaire form, we only analyzed the questionnaire forms of 9,578 patients who answered completely. RESULTS: 1. Approximately 85% of patients visiting outpatient orthopaedic clinics complained of pain. 2. The average degree of pain was more than moderate, and 72% of patients simply desired to be free of pain. 3. Seventeen percent of patients thought their physicians underestimated their pain. 4. Regarding agreement in the assessment of pain between physicians and patients, there was low level of agreement by numeric rating scale, but a high level of agreement based on a mild/moderate/severe grading scale. 5. Approximately one-third (36.2%) of patients had used additional treatments for pain relief on top of their prescribed medications. CONCLUSION: Eighty-five percent of patients complained of pain, and two-thirds of them were primarily focused on its relief in their visit to the outpatient clinic. Hence, we should heed pain management itself as an important goal in treating orthopaedic patients.

The Ultrasonographic Findings Related to Pain and FunctionalStatus in Patients with Knee Osteoarthritis

OBJECTIVE: To evaluate the usefulness of ultrasonographic (US) examination in patients with knee osteoarthritis (OA) and determine US findings associated with pain and functional status. METHOD: 45 patients with primary knee OA classified by the American College of Rheumatology (ACR) criteria were recruited. The severity of pain and functional status were measured by Lequesne index and Western Ontario and McMaster Universities Osteoarthritis Scores (WOMAC). All patients underwent US examination of their knees and plain radiography for Kellgren and Lawrence (KL) grade. RESULTS: Even in mild OA cases (KL G1, 2), patients had evidence of distended suprapatellar pouch (effusion) (32%), synovial thickening (12%), cartilage degeneration (32%) and medial capsular distension (72%). The severity of pain and functional status were found to be correlated with following US findings: amount of suprapatellar effusion (gamma=0.514, p<0.01), degree of synovial thickness (gamma=0.520, p<0.01), cartilage degeneration grade (gamma=0.594, p<0.01), length of medial capsular distension (gamma=0.426, p<0.01). However, the length of medial and lateral osteophytes, size of Baker's cyst, and clinical parameter such as age, disease duration and BMI score were not correlated with the severity of pain and functional status in OA patients. Following multiple regression analysis, the amount of effusion, synovial thickness and length of medial capsular distension were correlated with Lequesne and WOMAC functional status score (gamma2=0.635, p<0.05). CONCLUSION: Ultrasonographic assessment was useful for diagnosing knee OA. The severity of pain and function were highly associated with the amount of suprapatellar effusion, degree of synovial thickness, the length of medial capsular distension and grade of cartilage degeneration.

Intraosseous Ganglia of Scaphoid in Hand: Report of 2 Cases / 대한정형외과학회잡지

Ganglia in the wirst are frequent, but intraosseous ganglia of the carpal bone are uncommon. We report upon two patients with intraosseous ganglia that involved the scaphoid bone, review the literature.

Operative Treatment of Diaphyseal Forearm Fracture in Children / 대한정형외과학회잡지

PURPOSE: This article presents a retrospective study of treatment modality for children's diaphyseal forearm fractures. MATERIALS AND METHODS: A total 148 forearm fractures (October. 1997-October. 2001) were examined, of which 19 required operation, a teenager whose growth plate had closed was excluded from the study. 17 patients required intramedullary K-wire fixation, 2 patients required open reduction and plate fixation. Time to radiologic union, complications at the last follow up were evaluated. RESULTS: In 17 intramedullary K-wire fixation patients, the average time to union was 6 weeks and complications including 1 ulnar shortening, 1 pin infection, 1 osteomyelitis, which developed due to a patient's mistake. In 2 plating patients, average union time was 6 weeks with no complications. CONCLUSION: We think that the treatment method of pediatric forearm fracture should be decided upon based on the fracture site and type of fracture. Intramedullary K-wiring for diaphyseal forearm fracture is an effective method and we recommend that the wire is inserted across the physis in cases of diaphyseal fractures of the forearm bone close to the metaphysis. If the diaphyseal forearm fracture is refracture or a bony gap is shown at the fracture site, open reduction and plate fixation is needed. If reduction and fixation of the bone alone in a diaphyseal fracture of both forearm bones restores the stability of other fracture, fixation of the other bone can be avoided.

Patellar metastasis from Squamous Cell Carcinoma of the Larynx: A Case Report / 대한정형외과학회잡지

Metastatic tumors of the patella are rare, espicially metastasis of the head and neck carcinoma to the patella is exceedingly rarer still. We experienced a case of patellar metastatic cancer from laryngeal squamous cell carcinoma and report the clinical, radiographic and pathologic findings in detail.

Treatment of Lumbar Spinal Stenosis with Diabetes Mellitus / 대한척추외과학회지

STUDY DESIGN: This retrograde study was designed to compare the clinical features and postoperative clinical results between diabetic and non-diabetic patients who had been performed decompression and arthrodesis with instrumentation. SUMMARY OF LITERATURE REVIEW: There are controversies in the treatment results of diabetic patients. OBJECTIVE: To identify poor results in the patients of lumbar spinal stenosis accompanied diabetes mellitus and to find out variables influencing postoperative results among diabetics. MATERIALS AND METHODS: We analyzed 27 diabetic patients and sex, age-matched 27 non-diabetic patients who were diagnosed as lumbar spinal stenosis and operated from April, 1995 to December, 1998. In all patients, duration of symtoms, sensory and motor deficits, comorbidity, level of operations were investigated and in diabetics, duration of diabetes, amount of insulin administered before operation and presence of diabetic neuropathy were included. Clinical results, postoperative complications were compared between diabetics and non-diabetics. RESULTS: Considerable improvement was reported by 19(71%) in diabetic group and 21(78%) in non-diabetic group. Complication rate such as of infection and delayed wound healing was not higher in diabetic group than non-diabetic group. Duration of diabetes and amount of insulin before operation did not affected the result of operations. CONCLUSION: The outcome of surgery was similary successful in the two groups.

Morphologic Finding of the Posterior Cruciate Ligament on Magnetic Resonance Imaging in the Tear of the Anterior Cruciate Ligament

The purpose of this retrospective study was to compare the morphologic change of the posterior cruciate ligament (PCL) in the anterior cruciate ligament (ACL) tear group and control group by the quantitative analysis. The study groups of patients were; acute ACL tear group (21 patients), chronic ACL tear group (31 patients), and meniscus tear group (20 patients) that undertaken partial meniscectomy. To express curved shape of the PCL quantitatively, the authors made a line (basal line) between the femoral attachment and tib- ial attachment of the PCL and decided the point (apex) that was located most far away from the base line. And the authors made a line (line 1) between the femoral attachment and the apex of the PCL, another line (line 2) between the tibial attachment and the apex of the PCL, and quartered the base line; first quartile, Hl, second quartile, H2, and third quartile, H3. The authors measured the each angle between basal line and line 1 (angle a), between basal line and line 2 (angle b), each height of the PCL at each quartile (Hl, H2, H3) and at the apex of the PCL on the basal line (H4). Three groups were compared and examined which factor was able to decide whether the ACL was ruptured or nnt. Angle a was significantly higher in chronic ACL tear group than acute ACL tear group and meniscus tear group. In conclusion, the PCL of sigmoid or curled up shape is a more constant finding of chronic ACI tear than acute ACL tear.

Clinical Implications of Bone Bruises on MRI in Acute Traumatic ACL or PCL Injury / 대한정형외과학회잡지

PURPOSE: Bone bruises of patients with acute traumatic knee injuries, that are not found on simple radiograph, can be found on magnetic resonance imaging (MRI). The purpose of this study is to evaluate the frequency and locations of bone bruises on MRI in acute traumatic anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) injury. MATERIALS AND METHODS: 25 and 19 MRls, in which acute traumatic ACL and PCL injury was pre sent and there was no abnormality in simple radiograph, were reviewed. MRI was taken within 51 days of injury. A bone bruise was determined as a geographic and nonlinear area of signal loss on T1 images and increased signal intensity on T2 images involving the subcortical bone. RESULTS: In 16 patients with bone bruises and acute ACL injury, bone bruises were found in the lateral compartment of the knee in 15 (93.8%) patients. The most common area was the lateral tibial plateau (11 cases, 68.8%) and the second was lateral femoral condyle (9 cases, 56.3%). In 5 patients with bone bruises and acute PCL injury, bone bruises were found in the lateral compartment of the knee in all 5 (100%) patients. The most common area was lateral tibial plateau (4 cases, 80%) and the second was lateral femoral condyle (2 cases, 40%). CONCLUSIONS: In patients with acute traumatic ACL or PCL injuries the bone bruises are often found on the lateral compartment of the knee, especially lateral tibial plateau and lateral femoral condyle on MRI.

Tibial Tuberosity Avulsion Fracture Combined with Meniscal Tear: A Case Report / 대한정형외과학회잡지

Avulsion fractures of the tibial tuberosity are uncommon and they usually occur in adolescents during sports activities. Ogden et al modified Watson-Jones classification into three types. To our knowledge, only two cases of tibial tuberosity avulsion fractures combined with meniscal tear were reported. We report an Ogden-type III intra-articular fracture of the tibial tuberosity combined with tear of the medial meniscus.

Measurement of the Morphologic Changes of Intercondylar Notch by Magnetic Resonance Imaging / 대한정형외과학회잡지

The purpose of this retrospective study was to evaluate the morphology of the intercondylar notch of the knee in 72 anterior cruciate ligament (ACL) intact group and 30 acute and chronic ACL tear group by plain radiographs and MRI, and to find the predisposing factors of ACL tear. The ACL tear group was divided into acute and chronic ACL tear group. In plain lateral radio-graphs, beta angle, angle between extension line from anterior cortical line of distal femur and from Blumensaat s line, was measured. In magnetic resonance imaging, the width of intercondylar notch (NB), the widest width of both femoral condyle (NW), intercondylar notch width from lower one third point of notch basal line (NB1), intercondylar notch width from upper one third point of notch basal line (NB2), depth of intercondylar notch from notch basal line (ND), and intercondylar angle which made from both end point of notch basal line and apex of intercondylar notch (alpha) were measured. Three groups were compared with each other by statistical analysis. Stastistically, the acute ACL tear group had narrow upper portion of intercondylar notch than chronic ACL tear group and more acute angle of roof of the intercondylar notch than intact ACL group. So in notchplasty, the upper one-third of intercondylar notch should be carefully widened. And after fixation of femoral interference screw, arthroscopic observation should be done whether reconstruced graft touchs the roof of the intercondylar notch during the extension of the knee.

Morphologic change of PCL of MRI in the tear of ACL / 대한정형외과학회잡지

MRI has proved to be very reliable in evaluating the menisci and cruciate ligaments. On MRI, several diagnostic criteria of ruptured ACL were reported. Boeree and Ackyroyd reported that when the ACL is ruptured the PCL may appear to be curled up or sigmoid. But these morphologic changes may be shown in the normal ACL, so the quantitative analysis of these morphologic changes in considered as a way to increase the diagnostic sensitivity. We have used 1.0 tesla MRI scanner(SIMENS W. Germany) with a surface coil. We compared two groups of patients; a ruptured ACL group(16 patients) in which had indicated and arthroscopy confirmed rupture of the ACL and control group(46 patients), in which had shown the ACL to be entirely normal. At first, we made a line(basal line) between the femoral attachment and tibial attachment of the PCL and decided the point(apex) which was located far distant from the line. And we made a line(A line) between the femoral attachment and apex of the PCL, another line(B line) between the tibial attachment and apex of the PCL. We divided the basal line into the four areas. We measured the each angle between basal line and A line(angle a), between basal line and B line(angle b). And we measured the entire length of basal line, each height of the PCL previously divided point of the basal line(H1, H2, H3) and the apex of the PCL on the basal line. We compared the control group and ruptured ACL group by t-test from the measured factors angle a, angle b, H1, H2, H3, H4, and length of basal line. We studied factors which were able to decide whether the ACL was ruptured or not in MRI finding by logistic regression. 1. H1, the distance from the basal line to the PCL at 1/4 point on the basal line, were 5.7±1.6 mm in ruptured ACL group, 4.7±1.3 mm in control group, so there was statistically significant increase in ruptured ACL group. 2. The angle a were 56.0±14.4° in ruptured ACL group, 39.7±10.1° in control group, so there was statistically significant increase in ruptured ACL group. 3. From the measured factors angle a was able to decide whether the ACL was ruptured or not in MRI and the slope of angle a in logistic regression was 0.1. In conclusion, when the apex of the PCL is located at proximal 1/4 of the PCL and PCL and greater curve, above signs will be considered to be a sign of ruptured ACL in MRI.

Intraosseous Lipoma in the Calcaneus: A Case report / 대한정형외과학회잡지

Despite the large amount of adipose tissue in bone marrow, intraosseous lipoma is a very rare tumor. Since th first report by Cornil and Renvier in 1868 for a lipoma in the diaphysis of the femur, many cases of intraosseous lipomas of the limbs have been reported. For intraosseous lipoma, Dahlin reported an overall incidence of one per 1,000 bone tumors. Child reported the first case of intraosseous lipoma in the calcaneus. In Korea, a intraosseous lipoma in the fibula was reported only. We reported a case of intraosseous lipoma in the calcaneus.

Clinical Experiences of the Hip Arthroscopy / 대한정형외과학회잡지

Hip arthroscopy is technically demanding procedure and it is difficult to inspect the entire joint space. But with the development of instruments and the accumulation of results of research, the indications of hip arthroscopy are expanding. The operative arthroscopy of 18 joints was performed during the past four years. We used the supine position on the fracture table and anterolateral and lateral portals. Removal of traumatic loose bodies and synovial chondromatosis, lavage of pyogenic arthritis are excellent indications for the arthroscopic surgery of the hip joint. The results of the partial synovectomy and debridement for rheumatoid arthritis and other arthritis are satisfactory. The hip arthroscopy is beneficial to the diagnosis and treatment for the unexplained hip pain.

The Use of May Anatomical Bone Plate in The Treatment of Distal One / 대한정형외과학회잡지

Many modalities of the treatment of fractures of distal 1/3 of tibia were introduced. But, May anatomical bone plate is considered to be a valuable method in treating distal 1/3 tibial fractures because of reduction potentiality by their contour, ability of firm fixation, decreased complications. Twenty two patients having distal 1/3 tibial fractures, were treated by May anatomical bone plate, at the Department of Orthopedic Surgery, Inchon Chirstian Hospital from January 1988 to December 1993. The results were follows; 1. Ninteen cases(86%) out of 22 were closed fractures and the remaining 3 cases(14%) were open fracrues, the comminuted fractures were 6 cases(22%) and the segmental fractures were 2 cases(9%). 2. Average interval from injuy to operation was 16.8 days and 21 cases had associated injuries. 3. The mean duration of bone union was 16.9 weeks. 4. Seven cases(31.8%) of delayed union and two cases(9.1%) of superficial infection were noted.

The analysis of congenital anomalies in the lumbosacral area combined with the spondylolysis and the isthmic spondylolisthesis / 대한정형외과학회잡지

The incidence of the spondylolysis is very low before five years but during the adolescence the incidence increase. The etiologic factors of spondylolisthesis are congenital and acquired. The acquired factors are traumatic and stress fracture. Then there are many congenital properties of the etiologic factors for the spondylolisthesis because several congenital anomalies are combined with spondyolysis or isthmic spondylolisthesis. But there are few articles about relationship between the spondylolysis or isthmic spondylolisthesis and the congenital anomalies around the lumbosacral area. The purpose of this particular study is to search the etiologic factors that increase the degree of the vertebral slippage and relationship between the spondylolysis or ishtmic spondylolisthesis around the lumbosacral area. The plain X-ray and computed tomograms were taken in the 48 patients and the 26 control group that have not chronic low back pain previously. The patients were divided into three groups, such as the spondylolysis, grade I spondylolisthesis, and grade II spondylolisthesis. The parameters measured from the plain X-ray were the incidence of congenital anomalies and degree of vertebral slippate. The parameters measured from the computed tomograms were fact angles and the degree of pseudodisc. Tropism were present for 5 cases, and 16 cases at L3-4 facets, 12 cases, and 22 cases at L4-5 facets, 10 cases, and 28 cases at L5-S1 facets in control and patients group. There was no correlation between the presence or absence of tropism and the vertebral slippage. The sacralization was related with the vertebral slippage but other congenital anomalies were not related to the degree of vertebral slippage. There was a increment of vertebral slippage according to the increase of facet angle, but the linear correlation was absent on regression analysis. So statistical significance was absent among the control group and 3 patients groups. And the vertebral slippage was not significantly different among the groups that were divided according to the difference of facet angle. There was a linear correlation between the degree of the pseudodisc and the degree of vertebral slippage of square=0.60 on regression analysis. At present study, there was a trend of increase of vertebral slippage according to increase of facet angle and presence of the sacralization. And there was a linear correlation between the degree of the pseudodisc and the vertebral slippage.